Dr. Shin Seonhan: The Doctor Who Sees The Future [EN]: Chapter 187

Dr. A Fresh Surgeon – #187 Fresh Thoracic Surgeon (4)

Childhood.

I was a kid who was exceptionally good at using my hands.

Knives, scissors, various assemblies, and so on…….

It didn’t matter what it was.

I was obsessed with mastering any tool perfectly, and I wanted to put my talent to good use someday.

Was that the reason?

When I happened to watch a documentary about a medical professional, a ‘god in a white coat,’ I felt like my eyes lit up.

‘Cool… So that’s the world of a surgeon!’

I was so focused that I was completely absorbed in the screen.

What was shown was a CABG (Coronary Artery Bypass Graft) [a surgery to improve blood flow to the heart].

The surgeon was wearing magnifying loupes and ivory-colored gloves over a sky-blue surgical gown, standing at the operating table.

His gloves were stained red with hardened blood here and there.

I stared blankly at the surgeon’s fingers, moving quickly and precisely in the surgical field.

‘Can I do that too?’

Cutting, sewing…….

His hand movements were sharp and accurate, as if measured with a ruler.

Emotions were absent from the act of opening a person’s body and connecting blood vessels.

But why?

In that seemingly detached process, I paradoxically felt a burning passion.

‘I want to be in that position too.’

To the right of the patient.

The surgeon’s position.

From that day on, I had been envisioning the day I would stand in the same position as that surgeon.

And today.

In the exact same CABG surgery that I saw back then, I was about to hold the scalpel for the first time.

* * *

Beep―

The operating room door opens.

A CABG surgery usually takes 5-6 hours.

I entered room 16, where Kim Deok-sang’s surgery was taking place.

Bach’s calm melody was playing.

Professor Kim Seong-tak was the chief surgeon today, hence the classical music.

If it were Professor Heo Jun-im, it would have been the latest hip-hop music.

In this way, the chief surgeon’s preferences could be roughly discerned by the music in the operating room.

“Oh, you’re here?”

Dr. Ma Dong-seop greeted me.

Today, he was also wearing surgical loupes and a headlight on his forehead.

“You’re not nervous, are you?”

“I’m okay.”

“Hehe. You’ve observed a few times and assisted from the opposite side, so you’ll do great!”

“Oh~ Is Dr. Seon doing something today?”

The operating room nurse, who was busy preparing next to me, showed interest.

“Today, Seon-han is going to perform a sternotomy (sternum incision) [surgical procedure involving incision of the sternum]!”

“Oh, really? Do we buy coffee after a sternotomy *iwai* [celebration gift for a first surgery]? Hoho.”

*Iwai* (祝).

It means ‘celebration’ in Japanese.

It is a term used when performing the first surgery, likely a conventional expression passed down from older times.

Anyway, I think she was hinting that I should buy a celebratory treat for my first surgery.

“Of course. After it’s over, I’ll treat the thoracic surgeons to coffee.”

At my answer, Ma Dong-seop smiled and exchanged jokes with the nurse.

“Hey~ It’s a bit much to ask for a treat just for a sternotomy. Hehe.”

“I was trying to get something from an innocent first-year resident~ Should I still call you an intern?”

“Don’t tease him too much, and please get Seon-han a headlight too!”

“Yes~ Yes.”

Headlight.

It’s like a personal shadowless lamp that I wear on my head.

It provides extra light focused on my field of vision.

Especially in surgeries requiring precision, like heart surgery, it is essential to brighten the field of vision with a headlight.

“Here you go, Doctor.”

“Thank you.”

I put the headlight that the nurse gave me on my forehead.

Click―

When I pressed the button, a strong beam of light shone from my forehead.

‘I need to adjust the direction to best illuminate my field of vision…….’

The trick is simple.

First, place your left thumb in the direction of your gaze.

Then, adjust the position of the headlight with your right hand so that the light falls on your left thumb.

It was a bit awkward since it was my first time, but I adjusted it quickly because I had watched and learned how before.

“Did you adjust it okay?”

I nodded, tucking the end of the headlight cord into my back pocket.

“Okay, let’s scrub in and get ready.”

We finished disinfecting the patient and went to wash our hands at the sink.

“Just do what you’ve seen so far, and don’t be too nervous!”

“Thank you.”

“I’ll assist you, so there won’t be any problems.”

Dr. Ma Dong-seop’s confident demeanor was reassuring.

‘I can do it. I’ve searched and replayed the educational video dozens of times yesterday.’

Beep―

The operating room door opens again.

I stood on the right side of the patient, who was lying straight, and Dr. Ma Dong-seop stood on the left side as an assistant.

‘……I’m finally standing in this position.’

I was briefly lost in emotion.

Yeonguk University Hospital operating room, to the right of the patient.

It felt surreal because it was exactly where the surgeon I saw on TV as a child was standing.

Of course, I am not yet the chief surgeon.

I was just standing in the chief surgeon’s position for a moment to open the patient’s chest.

Still, my heart fluttered.

I felt like I had taken a step closer to the world I had longed for.

“Patient Kim Deok-sang, we will begin the CABG surgery!”

Dr. Ma Dong-seop announced.

I was about to reach out to the nurse.

However, the headlight was not aligned with my gaze.

‘Huh? I thought I had adjusted it well earlier…….’

When I hesitated, Dr. Ma Dong-seop immediately noticed.

“The headlight isn’t adjusted well, right? It’s tricky at first, hehe.”

I asked the circulating nurse to fine-tune the headlight.

These small details reminded me that I was still a newbie.

“That’s it.”

“Okay, let’s start!”

I reached out to the side.

“Black silk (suture thread), please.”

Ma Dong-seop nodded.

“That’s right. You don’t just rush in with a knife; you have to assess the area first.”

That’s right.

A median sternotomy should be performed in the exact center of the chest.

So the skin incision must also be in the center.

I first checked the center of the upper and lower parts of the sternum.

Then, I stretched out the thread I received from the nurse and pressed it against the patient’s skin, connecting the two points.

This created a visible groove on the patient’s skin.

“Yes, that’s how you mark the incision line and start.”

Dr. Ma Dong-seop instilled confidence in me.

I reached out to the nurse and spoke the words I had been anticipating for a long time.

“Scalpel!”

It was the first word I spoke as a fresh thoracic surgeon.

I was even more excited than when I received my acceptance letter for the thoracic surgery program.

I had always been waiting for this moment.

I will participate in more and more complex surgeries in the future, but as they say, a thousand-mile journey begins with a single step.

The first step in heart surgery, sternotomy.

I felt like I was walking on clouds.

“Scalpel here.”

Swish―

The feel of the metal on the glove was satisfying.

I received the scalpel and prepared to make an incision along the marked line.

But, at that moment―

“……!”

The surroundings became quiet.

Time seemed to slow down to 0.1x speed.

It felt like another reality was superimposed on top of this one.

‘I forgot for a moment. It’s been a while since I’ve experienced this…….’

A phenomenon that sometimes occurs when you hold a scalpel in front of a patient.

A vision that briefly shows the future surgical process unfolds before my eyes.

‘Last time, it showed me the surgery I had to do in advance…… Let’s focus and see if something goes wrong!’

I focused on the rapidly flowing images.

Incision.

Suction (aspirating blood to clear the field of vision).

Cauterizing with a bovie (surgical electric knife)…….

Soon the patient’s sternum began to appear.

‘It’s good so far…… Huh?’

However, blood suddenly welled up from the upper surface of the sternum.

Blood rose in a confined space where the field of vision was not yet clear, eventually overflowing onto the skin.

‘What is it? Did a blood vessel rupture somewhere?’

Flash―

The vision disappeared.

It was a short and intense glimpse.

I blinked a few times to shake off the afterimage.

‘What was the problem?’

I had studied that there are almost no bleeding events that cause significant harm to the patient during the sternotomy process.

But one thing is certain: if I proceed as planned…….

I will encounter a bleeding event during the initial sternotomy.

At that moment, a comment I heard in English in a video I watched yesterday flashed through my mind.

It was a sentence that could have been easily overlooked, but….

‘……That’s right. I think I know what the problem is.’

I could remember it because I had replayed it so many times in preparation for today.

I nodded, vaguely understanding the issue.

“Why, is there a problem?”

“No, not at all.”

I answered calmly.

If I had proceeded without seeing the future, I would have been caught off guard.

But since I know in advance which part will cause the problem…….

‘I can do it.’

Besides, Ma Dong-seop is right here and can help me at any time.

I decided to proceed, being mindful of the bleeding I saw in the vision.

Since I know the potential problems, I will be able to pay closer attention and respond accordingly.

“Incision going in.”

Swish―

I brought the scalpel to the patient’s body.

Following the marked line, I calmly drew the scalpel more than 20cm long.

‘This is the longest incision I’ve ever made.’

Streaks―

A line appeared on the skin.

It was different from making a 2cm incision when inserting a chest tube.

Gurgle―

Bright red blood flowed along the path of the scalpel.

Dr. Ma Dong-seop wiped the blood away with gauze and suction, clearing my field of vision.

“Good, the incision was good.”

Ma Dong-seop briefly praised my incision.

“Now, let’s go deeper with the bovie until the sternum is visible. As I said last time, you have to go between the pectoralis muscles on both sides, that’s the midline in the center! Okay?”

The muscles on both sides of our chest extend from the sternum in the middle of the body.

The space between these two chest muscles is the midline of the sternum.

What if you can’t make an incision in the center?

It can unnecessarily damage the ribs and cause problems with breathing exercises and wound healing after surgery.

In major surgeries such as heart surgery, even these small problems can threaten the patient’s life.

Therefore, it was important to make an incision in the middle of the sternum and suture it well.

“Bovie, please.”

I handed the scalpel to the nurse and grabbed the bovie.

Then, I carefully cauterized the fat layer under the skin and began to go deeper.

Sizzle―

Bovie.

This tool, which looks like a pen rather than a knife, has two buttons.

One for incision (cut) and one for hemostasis (coagulation).

It helps to adjust the current and voltage to suit its purpose.

As I used the bovie to stop the bleeding and peel off the fat layer, muscle fibers at the end of the pink muscle began to appear.

‘If you go to the place where the muscle fibers on both sides cross without damaging the muscles…… Yes, this is the midline!’

Between the muscles, the sternum finally began to appear.

Dr. Ma Dong-seop’s hand holding the suction also moved busily, and he pointed to the sternum I found while organizing it with the end of the suction.

“Okay, now let’s clean up from the bottom!”

The ‘bottom’ that Dr. Ma Dong-seop was talking about referred to the area around the xiphoid process [cartilaginous section at the lower end of the sternum].

The sternum is largely composed of three parts.

The upper part is the manubrium [the broad upper part of the sternum], the middle part is the body, and the xiphoid process, which is attached like a tail, is the three parts.

The xiphoid, which protrudes sharply, has a different shape for each person.

Thin people, thick people, people who protrude forward, etc…….

Just like people’s faces are different, the xiphoid is also different.

“This person has a pretty xiphoid, hehe. There’s nothing special! Let’s peel off the bottom of the xiphoid so that the sternotomy saw can enter.”

Under the guidance of Dr. Ma Dong-seop, I began to clean up the area around the xiphoid using a bovie.

Then, as I learned, I used a right angle forcep (surgical instrument) and my fingers to create space for the sternotomy saw to enter.

“Okay, if you’re done, let’s go to the upper neighborhood!”

The ‘upper neighborhood’ that Dr. Ma Dong-seop was talking about referred to the upper surface of the sternum, the manubrium.

‘It’s near here, the place where the bleeding occurs! I have to be careful here!’

I regained my concentration.

It’s my first time, but it doesn’t feel like my first time.

Is it because I saw the future?

My senses are sharper than usual, but I’m not nervous.

I moved my hand to the upper surface of the sternum, which was the problem.